New biomarkers in the diagnosis and prognosis of neonatal infections in respiratory distress syndrome

Abstract

Introduction. Bronchopulmonary dysplasia (BPD) and neonatal respiratory distress syndrome (nRDS) are major complications in preterm infants, often resulting in long-term health issues. Identifying reliable biomarkers for these conditions is crucial for improving clinical outcomes. Infectious diseases are a predominant cause of childhood death. Neonatal infection in particular remains a common tragedy, with ∼7 million cases and ∼700,000 deaths per year, currently accounting for 40% of mortality in those under 5 years of age (Hanieh Talebi et.all.2025). Objective: to summarize contemporary evidence on the use of circulating immunological biomarkers in the diagnosis of secondary immunodeficiencies and to identify promising biomarkers for use in personalized management in neonates. Material and methods: The study was analytical, based on a review of the scientific literature from the PubMed and Google Scholar databases, published between 2018 and 2023. Rezults. Studies have highlighted potential biomarkers and mechanisms involved in their pathogenesis. Endothelin-1 (ET-1) is a promising biomarker for predicting BPD, as it is associated with bronchoconstriction and pulmonary hypertension, with elevated levels indicating early risk in preterm infants with nRDS. Interleukin-6 (IL-6) is another significant biomarker, with higher serum levels correlating with BPD development, underscoring the role of inflammation in lung injury. Oxidative stress is also critical, as preterm infants have immature antioxidant defenses, leading to increased lung tissue damage. Specifically, neonatal APCs typically produce less proinflammatory (interleukin-1β [IL-1β], TNF-α) and T helper 1 (Th1) promoting cytokines (IL- 12p70, type 1 IFN), but equal or greater amounts of Th17 promoting cytokines (IL-23, IL-6) compared with adult cells. Robust neonatal production of IL-6 induces a physiological hepatic acute phase response at birth, including induction of mannose binding lectin (MBL), C-reactive protein (CRP), and LPS-binding protein (LBP) that rise in the first week of life, possibly broadly enhancing resistance to infection, and contributes to healing of tissues injured during birth. Conclusion. Biomarkers diagnosis in lung lesions in newborn children has a major diagnostic value for preventing infant mortality and evolution newborn management.